APPLICATION FORM FOR

NATIONAL LEVEL VENDOR DEVELOPMENT PROGRAMME – CUM- INDUSTRIAL EXHIBITION “MSME EXPO – 2017”

AT MSME-DI CAMPUS, B.T.ROAD, KOLKATA FROM 22.11.2017 to 24.11.2017

1. Name of the applicant (in block letters) :

2. Address for correspondence :

3. (a) Name & Address of the Industrial unit (MSME) :

With Phone No/Email ID

(b) Udyog Aadhar Number (Attach Copy) :

** (Mandatory) (c) PAN Card No. : 4. Product(s) being manufactured/ Services offered :

6. Details of Participation fee :

Stall Charges: (Please give a Tick Mark)

i) (6’ x10’) Area : - Rs. 3000/- for Micro ii) (8 x 10’) Area : - Rs. 8000/- + GST for Small iii) (10 x 10’) Area :- Rs. 10,000/-+ GST for Medium iv) (10 x 10’) Area :- Rs. 15,000/-+ GST for Government organization, Bank and

Other organization v) (10 x 10’) Area :- Rs. 20,000/-+ GST for CPSUs

Mode of Payment: - Demand Draft in favour of Director, MSME-DI, Kolkata (Payable at Kolkata)

Date: (Signature of the applicant)

(Seal)